A brief history of foot orthotics in the modern era.

Like all areas of medical science, there is always new knowledge coming from more recent and more detailed research. Before 2006 we knew that orthotic therapy was successful at treating the symptoms of pain in people’s feet. We knew this because outcome studies1 showed 80% of people had improvement using orthotics as their main therapy.

The main theory before 2006 was that orthotics stopped excessive rolling in of the foot and flattening of the arch. The idea of stopping excessive pronation was to support the foot in a normal position. Of course, there were several different opinions on what normal was! The problem with this theory was that after several RCT research projects, there was no clear evidence to prove it.

In 2006 a landmark study2 was published which researched the influence of custom foot orthotics on lower extremity dynamics. This was an extensive project that looked at all the ways orthotics could affect the foot and why they could be so beneficial. What this study found was that the height of the arch, the amount of rolling in of the foot or other parameters that had been viewed as important, were not shown to be significantly altered.

The only statistically significant change orthotics made were on the forces occurring through the feet!

Where do these forces come from?

If you were paying attention to science in high school, you will remember the equation F= MA, or force equals mass, (our body) times acceleration, (from gravity).

This force is generated at all times and affects your feet particularly in weight-bearing, when you are standing, walking and significantly when you’re running.

This force is transmitted through your skeletal structure with a supportive network of soft tissues, (ligaments, tendons, fascia, muscles, etc). All this provides stability to assist the transmission of force when you move, that is, in dynamic function. This amazing ability is called Tensegrity.

Wikipedia says “Tensegrity, tensional integrity or floating compression, is a structural principle based on the use of isolated components in compression inside a net of continuous tension, in such a way that the compressed members (usually bars or struts) do not touch each other and the prestressed tensioned members (usually cables or tendons) delineate the system spatially.” Wow!

No body’s perfect, however. We all have some skeletal misalignment from our genetic heritage. A minor misalignment is usually no problem but if you have something more significant like a twist in the spine, (scoliosis), legs that are bowed, (an excessive internal / external twist in the lower legs) or a leg length difference greater than 6 mm, the placement of the force will not be optimum and will force your body to compensate. Compensation of skeletal misalignment will often place forces on other parts of the body.

So, where does the force go? It travels through your legs and into the foot, to the ground. Not only does the foot have to adapt to the body’s misalignments, it also has to be able to function on lots of different surfaces, like walking on the side of a hill, or in sand or over rocks.

Leonardo da Vinci said “The human foot is a masterpiece of engineering and a work of art “and I wholeheartedly agree with him!

To return to our high school science, another law of physics we learnt was Newton’s third law, ”For every action, there is an equal and opposite reaction”.

As bizarre as this sounds, as you place your body weight onto the ground through your foot, there is an opposite and equal force from the ground pushing into the foot; we call this ‘ground reaction force’. Ground reaction force loads the foot from below, while your body is loading the foot from above.

If the force occurs on structures that are not able to withstand them and for a prolonged period of time, the risk of injury is significantly increased. If an injury does occur and the excessive forces are not reduced or removed a chronic pain or only partial healing will result. When the healing tissues are exposed to the excessive forces and become reinjured, a cycle of healing and reinjury occurs where the body never returns to the state it was prior to the injury.

May the force be with you!

The effect of force on your body is why rest and gradual and paced return into activity is so important. You need time to allow the injured tissues to adapt to the stresses and be able to withstand them.

Excessive forces can be reduced, managed and redirected. Your muscle flexibility and strength, your joint mobility, footwear choice and orthotics may all play a part.

At Total Care Podiatry we have specialist equipment and expertise in musculoskeletal podiatry and physiotherapy to analyse, diagnose and address the excessive forces your body is trying to cope with. Our holistic approach will help you through your rehabilitation and reduce your risk of further injury in the future.

WARNING:This information is for educational purposes only and is not intended to replace professional podiatric advice. Treatment will vary between individuals depending upon your diagnosis and presenting complaint. An accurate diagnosis can only be made following personal consultation with a Podiatrist.

http://totalcarepodiatry.com.au/wp-content/uploads/2016/12/WALKING-SKELETON.jpg528395devhttp://totalcarepodiatry.com.au/wp-content/uploads/2017/03/logo-maroon.pngdev2017-12-14 01:34:562018-03-06 21:22:12May the force be with you

Paul Graham has been using plantar pressure analysis as part of his clinical practice since first purchasing an Fscan Mat and in-shoe system in 1998. It was a steep learning curve to understand the information behind the pretty colours and what it means. This form of analysis was in its infancy in Australia, and the only way of gaining an appreciable understanding of what the data represented and how could be used in clinical practice was gained through regular email and phone contact with a number of American podiatrists who had been using the Fscan system for many years.

The most well-known of these practitioners is Dr Howard Dannenberg and through this relationship Paul grew to understand the relationship of sagittal plane movement and the importance of how the foot has a significant effect on the rest of the body. In fact Paul’s foundational knowledge of recording, data management and analysis came through Howard’s leadership and the plantar pressure case studies that were shared. This knowledge base was further augmented when Dr Bruce Williams DPM, a protégé of Howard’s training, visited Australia in 2004 and stayed with Paul in Geelong, working and training him in his clinic. In 2005, Paul was invited to Latrobe University to present on his clinical use of plantar pressure in the prescription of the orthotic correction design.

Up until this stage, Paul was combining evidence-based examination and video gait assessment with plantar pressure analysis and, through this orthotic manufacture. The issue was that each part of the assessment used different equipment. In 2006 Paul moved to the Milletrex system, (forerunner of the Freestep software and Sensormedica hardware) and as this combined all aspects of the diagnostic and manufacturing process, he moved to this system. Again a learning curve was required to become familiar with the different parts of the system, however planter pressure is planter pressure and as such, once you understand the recording and data management side, analysis can be done.

In late 2010, the Freestep software program was presented and the engineers in Italy were keen to make it the best on the market. Through the years there have been regular updates making the program more user-friendly and the data presentation more valuable and easy to understand. In fact at present Paul is working with Scott Sorenson and the Italian software developers to enhance this further so that areas of dysfunction and asymmetry are easily noted and measured,. This will be valuable for both the initial assessment and also to easily chart improvement at review appointments. This continued refinement and development, makes Freestep a very valuable clinical tool.

Plantar pressure analysis can only grow in significance as it shows objective data that the eye cannot see. This is now even more important with the discovery that vertical force,( that we describe as pressure), is what causes the overloading that results in tissue damage, rather than any angular anomaly such as an inverted heel or lowering of the medial longitudinal arch. Using Freestep enables Paul to chart improvement effectively and efficiently each visit by simply having a person walk over the mat or treadmill and comparing it to the previous visit; all within five minutes. This is then a record of the patient’s progress, valuable, not only to the treating clinician, but also to any third party who is paying for the treatment.

Video gait assessment is very, very helpful in understanding the biomechanics of the body in motion and should be used in conjunction with planter pressure analysis; however Paul’s clinical use of plantar pressure analysis has led him to the conclusion that it is superior in consistency, ease and speed.